Just a Whiny Vent ("My New Insurance")

[almosthome 91]

Note: I am extraordinarily grateful to have health insurance and understand there are many whose plans don't cover bariatric surgery. This post is simply a reflection of my current feelings and frustrations regarding unmet expectations -- expectations I thought were completely reasonable.

On December 1, 2013, I was finally able to select a Blue Cross Blue Shield plan in Illinois through healthcare.gov. It was such a relief to finally be able to get medical care without sky-high out-of-pocket expenses.

But BCBSIL messed up my application processing. First, they cancelled my medical insurance when my dental application came in and had to reinstate the coverage (thankfully, still effective January 1). Second, they invoiced incorrectly, showing I only paid through January, so providers were blocked from the preapproval system. I couldn't even get my prescriptions covered despite having fully paid my premiums.

After >20 hours (of my time) on the phone and nearly a month since BCBSIL first fully identified the problems, my providers still can't submit pre-approval requests, and I still have to pay out-of-pocket for prescriptions. I filed a complaint with the state insurance board but don't know how much that will accomplish or how long a resolution will take.

Re: Sleeve - BCBS in IL (and other states) does not require a supervised diet, so I expected fast approval for the sleeve. Originally I had hoped for February surgery. Then I hoped for March. Now it's looking like late April, which leaves me in a difficult position. This spring was a convenient time for surgery. I'm just writing my masters thesis and looking for work. If surgery comes too late, though, it could necessitate delaying regular work. It's beyond irritating.

Thanks for letting me vent! <3

[almosthome 91]

A clarification: the initial delays were due to the hospital's pre-submission process.

[sleeve30 33]

I'm confused... They haven't approved you since January?

[almosthome 91]

The insurance company's computer system won't allow an electronic pre-approval request for an inactive member. Faxed/mailed pre-approval requests (for inactive members) are automatically trashed.

Since the BCBSIL computer system still thinks I am inactive (not paid up), the hospital cannot successfully submit my pre-approval request because the insurance company blocks or disposes of it. The hospital has been trying since Febraury 25th.

Edited March 16, 2014 by almosthome

[sleeve30 33]

Oh wow I'm sorry to hear that. I hope you get your approval in a timely manner... Have you met all requirements? I just applied for insurance myself... I chose BCBS NJ but I've not heard from them.

Don't lose hope it will happen for you and for me too!!

[almosthome 91]

Thanks for your encouragement, sleeve30. I have met all the requirements and am just waiting on the fix.

Congrats on getting coverage for yourself! Don't be afraid to pester the insurance company with calls if you don't hear from them soon!

[sleeve30 33]

You are welcome!

I'm tired of this wait to be honest. I've been waiting to have surgery since Aug 2013. I don't even know if I want to anymore.

[Seela 1,187]

Even without all those complications it took me six months. Trust me, it's worth the wait

[sleeve30 33]

Almosthome, how are you doing? I just received an update from BCBS NJ and I have been accepted, so my coverage starts April 1. I have done all the evaluations and testings ... I do not have supervised diet documentations...I hope that's not a problem :s

[almosthome 91]

The NJ approval criteria don't specify a supervised diet, so hopefully you're all set. Yayhoo!

I contacted the hospital earlier this week, and they said they were still trying to find a way to submit the pre-certification request. Also tried several phone numbers at BCBSIL and was unable to reach a live person. :/ Oh, well.

Edited March 20, 2014 by almosthome

[sleeve30 33]

I don't understand why it's so complicated for them to get it straighten out for you...

[beeteroo 166]

I looked at the coverage in my state and it doesn't even cover bariatrics! I could quit my job and get on Medicaid and get covered but my state doesn't offer bariatric services for their Obamacare plans. Thankfully I have coverage through my husbands job and we don't need to use the affordable care act.

[almosthome 91]

Today I called the hospital again, and the insurance coordinator said she thinks my request has now been submitted. She sounded busy, though, and didn't actually go look. :/

[almosthome 91]

You'd think ACA would include at least the minimum benefits provided under Medicaid. It's weird.

[sleeve30 33]

Ok great! I hope they did submit it!!! Keep me posted!